risk has decreased with new tendon fixation techniques that require less dissection in the antecubital fossa

synostosis and resulting loss of pronation/supination

avoid exposing periosteum of ulna

avoid dissection between the radius and ulna

heterotopic ossification

less common than with 2 incision technique

postoperative

immobilize in 110° of flexion and moderate supination

Dual Incision Technique

developed to avoid injury to radial nerve/PIN

technique

uses smaller anterior incision over the antecubital fossa and a second posterolateral elbow incision

posterior interval is between ECU and EDC

avoid exposing ulna

do NOT use interval between ECU/anconeus (Kocher's interval) or anconeus and ulna

anterior dissection is same as single incision described above

after the biceps is identified, the radial tuberosity is palpated, and a blunt, curved hemostat is placed in the interosseous space along the medial border of the tuberosity and palpated on the dorsal proximal forearm

hemostat pierces anconeus and tents the skin indicating where the posterolateral incision should be made

complications

LABCN injury is most common

synostosis and heterotopic ossification more common with 2 incision than single incision

(OBQ12.204)
A 44-year-old left-hand dominant carpenter experienced immediate left elbow pain after trying to stop a heavy object from falling two days ago. Figure A shows a clinical image of the patient upon presentation. Physical exam shows full strength with wrist flexion, wrist extension, and pronation, but notable weakness with supination of the forearm. Sensory exam shows no deficits in the forearm or hand. There is a negative milking maneuver test and a positive hook test. Radiographs are shown in Figure B. What is the next most appropriate step in management?
Review Topic

(OBQ11.213)
A patient presents to your office for evaluation of arm pain. Upon evaluation, a diagnosis of rupture of the long head of the biceps tendon is made. Which of the following photographs would best corroborate this diagnosis?
Review Topic

(OBQ08.83)
A 35-year-old carpenter has pain in the antecubital fossa that is worse with turning a screwdriver. He has undergone non-operative treatment for 6 months without relief. On physical examination his hook test is normal and there is pain and weakness with resisted supination. Radiographs are shown in Figures A-C. A MRI of the right elbow is shown in Figure D. The next most appropriate treatment is?
Review Topic

(OBQ04.151)
A 42-year-old male has a suspected distal biceps rupture with a tendon that can be palpated but is painful during the hook test examination. Which of the following is the most appropriate next step?
Review Topic

QID:
1256

1

Operative exploration of distal biceps tendon

5%

(22/432)

2

Immobilization for three weeks followed by repeat physical examination

(OBQ09.96)
A 40-year-old male was moving his furniture several days ago when he developed anterior forearm pain. On physical exam he is tender just distal to the antecubital fossa. He has decreased strength on supination and elbow flexion when compared to the contralateral side. His MRI is shown in Figures A and B. His injury typically occurs in what portion of the tendon’s distal insertion?
Review Topic

(OBQ11.170)
A 28-year-old male sustains a distal biceps rupture while lifting a heavy table and elects to undergo surgical repair using a two-incision technique. What is the most likely neurologic deficit to occur as a complication of this surgical approach?
Review Topic